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This is VAERS ID 1041839

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1041839
VAERS Form:2
Age:72.0
Sex:Female
Location:West Virginia
Vaccinated:2021-02-14
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix 40 mg PO QD Vit D3 50,000 Units PO weekly MVI 1 tab PO QD Calcium Carbonate 600 mg1 PO QD Lantus 28 Units SQ in morning, 24 Units at dinner Iron 65 mg PO QD Monurol 3 gm PO, 3 pkts weekly Colesevelam 3.75 gm oral 1 pkt BID Plavix 7
Current Illness: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Preexisting Conditions: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Allergies: Sulfur
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Death- ~ 7 hours after vaccine


Changed on 5/7/2021

VAERS ID: 1041839 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:West Virginia
Vaccinated:2021-02-14
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix 40 mg PO QD Vit D3 50,000 Units PO weekly MVI 1 tab PO QD Calcium Carbonate 600 mg1 PO QD Lantus 28 Units SQ in morning, 24 Units at dinner Iron 65 mg PO QD Monurol 3 gm PO, 3 pkts weekly Colesevelam 3.75 gm oral 1 pkt BID Plavix 7
Current Illness: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Preexisting Conditions: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Allergies: Sulfur Sulfur
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Death- ~ 7 hours after vaccine


Changed on 5/14/2021

VAERS ID: 1041839 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:West Virginia
Vaccinated:2021-02-14
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix 40 mg PO QD Vit D3 50,000 Units PO weekly MVI 1 tab PO QD Calcium Carbonate 600 mg1 PO QD Lantus 28 Units SQ in morning, 24 Units at dinner Iron 65 mg PO QD Monurol 3 gm PO, 3 pkts weekly Colesevelam 3.75 gm oral 1 pkt BID Plavix 7
Current Illness: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Preexisting Conditions: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Allergies: Sulfur Sulfur
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Death- ~ 7 hours after vaccine

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1041839&WAYBACKHISTORY=ON

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